Depression and Pain in Retired Professional Football Players

Thomas L. Schwenk; Daniel W. Gorenflo; Richard R. Dopp; Eric Hipple


Med Sci Sports Exerc. 2007;39(4):599-605. 

In This Article


The sample of subjects to be surveyed was obtained from the active membership list of the NFLPA, retired players section (NFLPA-RP). A total of 3377 surveys were sent to retired players via surface mail. Reminder postcards were mailed 1 wk later, followed by a second survey mailed to all nonrespondents approximately 1 month after the initial mailing. Follow-up surveys of nonrespondents to assess the comparability of respondents and nonrespondents could not be conducted, because of financial and logistic constraints.

Each survey contained a cover letter that described the purpose of the survey and assured respondents that responses were completely confidential and would in no way affect their membership in the NFLPA. Names were connected with responses in a master list of names and identification codes kept in a locked and secured location. The cover letter carried the NFLPA-RP logo and was signed by the executive director of the NFLPA-RP. A waiver of the documentation of informed consent was approved by the institutional review board of the University of Michigan (#2005-279), based on minimal risk and the documentation of appropriate procedures to maintain confidentiality of all responses.

The survey assessed the experience of respondents with a range of life problems following retirement, such as employment, marital or financial problems, the barriers to receiving help for these problems, and the types of programs that might be helpful for retired players. The survey included a structured depression questionnaire (see below), a single question regarding chronic pain, and demographic questions.

Depression symptoms were measured by the PHQ-9, a validated screening questionnaire based on standardized diagnostic criteria,[11,21] including an assessment of the impact of depressive symptoms on personal and work roles. A self-rating of health status was made on a five-point scale, followed by assessments of past or current difficulties with nutrition, exercise, alcohol use, smoking, and depression. Respondents were asked additional questions about problems with alcohol and the impact of chronic pain on normal work.

The survey was pilot tested with the Detroit chapter of the NFLPA-RP, resulting in several modifications to its final form.

Simple frequencies and summary statistics were calculated on all variables. The PHQ-9 responses were calculated to create a binomial depression severity classification using standardized cutoffs[11,21] to distinguish between no or mild depression versus moderate to severe depression. A binomial variable was also created from responses to the item "difficulty with pain," with "very" or "quite common" considered high pain, and "somewhat" or "not common" considered low pain. Using t-tests, chi-square where appropriate, comparisons were made between all items and both the depression severity classification and the pain ratings. In addition, a similar analysis was conducted using a variable created by combining the two categorizations of depression (high vs low) and two categorizations of pain (high vs low), resulting in four mutually exclusive groups (high depression/high pain, high depression/low pain, low depression/high pain, low depression/low pain).


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